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Insurance Restrictions on Acne Drug are Outmoded and Costly

Insurance companies could save money and make the lives of doctors and their adult acne patients easier by reducing or eliminating the restrictions for dispensing the acne drug tretinoin, according to dermatologists at Wake Forest University Baptist Medical Center.

In a paper published in the April issue of The American Journal of Managed Care, Steven R. Feldman, M.D., Ph.D., and several colleagues reported that insurance companies are losing money by requiring prior authorization for all tretinoin prescriptions for patients over 25 years old.

The restrictions are a relic from the days when the drug, sold under the brand name Retin-A, was discovered to also have applications for cosmetic problems, such as wrinkles, said Feldman, associate professor of dermatology and pathology.

"The insurance companies were very worried that everyone in the country with wrinkles would start using Retin-A, so they decided that it needed prior authorization," he said. However, a form of tretinoin sold under the brand name Renova has been show to be better at fighting wrinkles, leaving Retin-A as a drug primarily for treating acne.

Insurance companies require prior authorization to restrict the use of costly or newly introduced drugs. Insurance will not pay for the cost of the drug unless the doctor first gets authorization to prescribe it for a specific patient.

In the belief that acne is mostly an affliction of teen-agers and young adults, and that older patients want the drug mostly for wrinkles, many insurance companies limit or deny payment for older patients who use tretinoin.

Previous research by Feldman and Alan B. Fleischer Jr., M.D., showed, however, that among patients 33 years old, 75 percent of all tretinoin prescriptions were for acne, and even at age 40, 63 percent of prescriptions were for acne.

According to the American Academy of Dermatology, acne is the most common skin problem in the United States, affecting up to 80 percent of people in their 20s and 30s.

Given these results, insurance companies are paying a high administrative cost for requiring prior authorization of prescriptions that they''re going to end up approving anyway for older patients, Feldman, Fleischer, and G. John Chen, M.D., M.P.H.,found.

The actual cost of unnecessary authorization depends on how much each insurance company pays for tretinoin and how much it pays for each authorization.

"Even if you pick the ideal age for prior authorization, our study shows that the insurance companies are saving only a small amount," Feldman said. "So the insurers are not gaining much of anything, and the patients and the physicians are going through a lot of inconvenience.

"The bottom line is there was this big concern about Retin A, which we now know has only a mild effect on wrinkles. There isn''t this demand for non-acne use of Retin A, so the requirement for prior authorization is a dinosaur."

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